I hereby grant the use of my arts/writing of the exercises I have selected on this form, along with associated information, as defined by the conditions and purposes above to Laury Rappaport and the Focusing and Expressive Arts Institute in perpetuity. I give express consent to the altering or editing of the aforementioned work for editorial purposes and waive the right to inspection or approval of the finished product. I attest that I am the original creator of my arts/writing and have voluntarily submitted my work for use. I acknowledge that once I sign and submit this form, I will have three (3) days to withdraw my consent.

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Note: The name that will accompany your art/writing will follow your preference of anonymity choice established in this form. All other information you submit on this form is protected and will be kept only for the Focusing and Expressive Arts Institute's private records.